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Covering the cost of cancer care

Author: Jeff Samoray

Battling cancer is hard enough, let alone worrying about co-pays, deductibles,
medication costs, and sometimes travel expenses. In an era of soaring medical
costs, patients often focus more on their bills than their health. Some patients
even delay or forgo treatment due to mounting or unforeseen medical expenses.
Cancer treatment costs can escalate quickly, and even if the insurance company
covers the treatment or medication, a patient may have to absorb a large out-of-pocket
expense. For some patients, exceeding their maximum annual or lifetime medical benefits is
a real possibility.

There’s no question that medical expenses can be a burden, but resources are available to
help patients manage the high cost of cancer care as they undergo treatment.

Insurance matters

“The last thing we want to do is bring patients
into treatment, help them through
their illness, and then send them medical
bills that they can’t afford,” says
Lisa Whiteside, director of the First
Connections team at Cancer Treatment
Centers of America® (CTCA) in Zion,
Illinois. First Connections is a concierge
service that welcomes new patients to
CTCA and helps them begin treatment.
“It’s important that patients are informed
up front about the financial aspect of their
care so that they can avoid any unnecessary
surprises.”

Whiteside recommends that, before beginning
treatment, patients review their
medical insurance policies and consult
their employee benefits administrator so
that they understand out-of-pocket costs
and coverage limitations. All health insurance
carriers are required to provide
their members with a Summary Plan
Description containing details about specific
coverage benefits. Patients should get
to know this document well and should
also carefully examine all “explanation of
benefits” statements and other insurance
documents they receive.

Because these insurance documents
aren’t always patient-friendly, it’s important
to know that there is help available
when it comes to deciphering the sometimes-
confusing insurance-speak; many
hospitals and patient advocate groups
have staff trained to help patients wade
through the paperwork so that they can
make informed decisions about their care.
“The First Connections team has seasoned
financial advocates who can help patients
enroll in insurance plans and better understand
their policies,” Whiteside says.

“They can also assist patients in discussing
denied claims with their insurance
providers.”

The range of issues and concerns that
patients face is broad, Moraratty says, but
she encourages all patients to reach out
because there is likely a suitable organization
or service that can help. “Some
patients have insurance coverage, while
others don’t. Some need funds to buy
medications; others have had insurance
claims denied. We help connect patients
to organizations that provide assistance.”
In addition to connecting patients with
appropriate resources, Moraratty says
PAF can help directly with insurance
questions and appeals. “We empower patients
to make appeals to their insurance
companies to resolve insurance matters,”
she says, adding, “In our past fiscal year,
we handled more than 88,000 requests
for assistance.”

Deductibles, co-pays and prescriptions

In recent years employers have trimmed
benefits and shifted higher insurance deductibles
and co-pays onto their employees.
As a result, patients are facing higher
up-front costs for treatment.

“Group insurance coverage isn’t what it
used to be,” Whiteside says. “Many people
have annual deductibles of $2,500 or
$5,000. Patients should be aware of these
costs and find out if their plan requires
them to use certain designated health
care providers or if they can choose their
own. Deductibles can vary depending on
whether you choose an in-network or an
out-of-network provider.”

CTCA offers a Financial Hardship
program to help qualified patients who
experience financial difficulties while undergoing
treatment. “We look at factors
such as income statements, account summaries,
and financial history to create a
customized payment plan for the patient,”
Whiteside says.

Patient Advocate Foundation offers a
Co-Pay Relief Program to help patients
manage pharmaceutical co-payments.
“Our case managers look at all resources
and programs that might help patients
absorb the cost of prescription expenses,”
Moraratty says. “That might include mailorder
prescriptions, available state and
federal funds, or prescription drug cards.
Our program also includes a 12-month
‘look-back’ period that can help patients
pay outstanding pharmaceutical bills.”

Travel expenses

Cancer patients with complex cases often
travel outside their local area to hospitals
specializing in certain therapies or treatments.
Patients may have to pay for airfare,
car rental, food, and lodging. These
costs increase when a family member or
companion accompanies the patient.

Like many destination hospitals, CTCA
offers travel-planning and coordination services. “For certain patients, we can
cover airline or train costs and reimburse
patients for miles driven,” Whiteside says.
“We also offer on-site and off-site lodging
at reduced rates, complimentary transportation
services to and from the hospital,
and discounted meal tickets.”

For cancer patients who don’t qualify
for travel assistance programs, there are
a number of air travel companies that
offer free or reduced-fare transportation
services. The Air Charity Network,
for example, can help arrange flights for
patients in all 50 states. The Corporate
Angel Network helps patients fly for free
in empty seats on corporate jets.

Remain informed

Above all, Whiteside says, patients need
to understand their medical coverage,
contact their insurance providers when
necessary, and know that assistance programs
are available to help qualified patients
manage their financial issues.

“Some cancer patients have policies
with a $200,000 or $500,000 lifetime
maximum, but that can be exhausted
quickly,” she says. “Patients should take
those numbers into consideration before
starting treatment. Some patients have
also been able to negotiate discounts off
certain medical charges with their provider
to help preserve their lifetime maximum.

“It’s all about being an informed patient—
the more aware you are up front
about the financial aspects of your care,
the more comfortable you’ll be during
treatment.”

Additional Resources

The following organizations are among those that help cancer patients with
financial, co-pay, medication, and travel costs. Contact them directly to learn
about program specifics and eligibility requirements.